1598862799 NPI number — DR. CHESTER CHURCH BUCKENMAIER III M.D.

Table of content: DR. CHESTER CHURCH BUCKENMAIER III M.D. (NPI 1598862799)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598862799 NPI number — DR. CHESTER CHURCH BUCKENMAIER III M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUCKENMAIER
Provider First Name:
CHESTER
Provider Middle Name:
CHURCH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598862799
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2420 POWDERHORN WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAMBRILLS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21054-1672
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-721-1892
Provider Business Mailing Address Fax Number:
410-782-5066

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
WALTER REED ARMY MEDICAL CTR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20307-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-782-2949
Provider Business Practice Location Address Fax Number:
202-782-5066
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  9300661 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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